HEALTH CARE Compliance & engagement Solutions

The forty-four Accountable Care Organizations (ACOs) currently participating in the Medicare Next Generation ACO Model (Next Gen) have a proven track record of coordinating care for patient populations.[1]  At this very moment, they are sinking their teeth into the Benefit Enhancements (i.e. Telehealth Expansion, Post-Discharge Home Visit Waiver, SNF 3-Day Waiver) that were created to help these ACOs further engage beneficiaries and improve their health.  The ACO environment is rather entrepreneurial in nature; resources and time can be in short supply and high demand.  It’s natural for ACOs to be narrowly focused on meeting CMS requirements, checking operational boxes (i.e. collecting quality measures), and building vendor-partner relationships. But are they missing the diamond in the rough?

The Coordinated Care Reward, a $25 pay-out from CMS to Medicare Fee-For-Service beneficiaries (Beneficiaries) who receive a Medicare Annual Wellness Visit from a Next Gen ACO provider,[2] is the one piece of the Next Gen ACO puzzle that may actually make sense to a patient. The Next Gen initiatives (e.g. Voluntary Alignment) and Benefit Enhancements can be difficult to communicate; however, the Coordinated Care Reward is a terrific way to dip a Beneficiary’s toe into the value of a Next Gen ACO and tee-up those more complicated communications.

Next Gen ACO participating providers can leverage the Coordinated Care Reward and use it as an opportunity to open dialogue with Beneficiaries.  This dialogue can help (1) encourage participation in an Annual Wellness Visit, (2) explain the provider’s role in the Next Gen ACO, and (3) offer a glimpse into upcoming initiatives that require the Beneficiary’s input (i.e. Voluntary Alignment, CAHPS). Communication about the Coordinated Care Reward can be as simple as a conversation between a practice manager or physician and a Beneficiary, or more formal, such as brochures, messaging on the office check-in kiosk or television, or a featured article in the ACO’s magazine.

When a Next Gen ACO decides to implement a Coordinated Care Reward communication plan, they should consider the following: 

  • File marketing materials for approval with CMS/CMMI prior to communicating to Beneficiaries. Additional guidance can be found in the Next Gen ACO Model Participation Agreement Section V.E.  Plan for the 10 day file & use requirement when building timelines.
  • Leverage existing CMS language to build tailored communication and educate participating providers and office staff.  Since they are on the front lines, office staff should be equipped with resources to help prepare them for questions coming from Beneficiaries. These are two pieces that are particularly informative:
  • Collaborate with ACO providers to create a communication strategy that is meaningful to their Beneficiaries, garners buy-in for outreach and aligns with their practice operations.
  • Remind practices of the appropriate billing codes to make sure Beneficiaries who complete their Annual Wellness Visit actually receive the Coordinated Care Reward.  Be careful not to cross the line into directing the practices on how to bill.

Since CMS manages and provides the infrastructure for the claims analysis and distribution of checks to Beneficiaries, Next Gen ACOs only have to invest in a marketing strategy to build a successful program. There should be little question as to whether or not communication about the Coordinated Care Reward should be employed as an opportunity to further engage Beneficiaries. The Annual Wellness Visit, which the Coordinated Care Reward is directly tied to, is a hugely important service not only for the Beneficiary’s overall health but also ACO quality measures and alignment. If talking to Beneficiaries about the Coordinated Care Reward drives more participation in Annual Wellness Visits and greater overall engagement and awareness of ACO initiatives, the Next Gen ACO could make a tremendous impact in improving care and outcomes.

If your ACO is ready to build a Coordinated Care Reward communication strategy but isn’t quite sure where to begin, Wilems Resource Group can help.  We are a boutique consulting firm specializing in Compliance and Engagement solutions for the Medicare Shared Savings Program and Next Generation ACO Model. We measure success on our ability to help our clients understand program requirements, determine the appropriate level of acceptable compliance risk, and create programming that meets all regulatory requirements. We build customized compliance and engagement programs for ACOs, physicians, practice managers, and beneficiaries.  We are #raisingourlegacy.

[1] “Next Generation ACO Model.” Centers for Medicare & Medicaid Services. Last updated: June 29, 2017.
[2] “Coordinated Care Reward.” Centers for Medicare & Medicaid Services. Release date: June 28, 2017.

Questions or Comments?

Contact Maddie 

Coordinated Care Reward


Maddie Short, Wilems Resource Group